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https://hdl.handle.net/2440/9935
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Type: | Journal article |
Title: | The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon |
Author: | Beltrame, J. Turner, S. Leslie, S. Solomon, P. Freedman, S. Horowitz, J. |
Citation: | Journal of the American College of Cardiology, 2004; 44(1):57-62 |
Publisher: | Elsevier Science Inc |
Issue Date: | 2004 |
ISSN: | 0735-1097 1558-3597 |
Statement of Responsibility: | John F. Beltrame, Stuart P. Turner, Sue L. Leslie, Patty Solomon, Saul B. Freedman and John D. Horowitz |
Abstract: | Objectives: The aim of the study was to assess the angiographic and clinical benefits of the calcium T-channel blocker, mibefradil, in the coronary slow flow phenomenon (CSFP). Background: The CSFP is characterized by delayed vessel opacification on angiography (Thrombolysis In Myocardial Infarction [TIMI]-2 flow) in the absence of obstructive epicardial coronary disease and is often associated with recurrent chest pain. Methods: A total of 10 CSFP patients (46 ± 9 years) underwent angiography before and 30 min after 50 mg mibefradil; off-line blinded analysis of angiographic data included comparisons of epicardial vessel diameter, TIMI flow grade and TIMI frame count. We also performed a randomized, double-blind, placebo-controlled, cross-over study to examine the long-term efficacy of mibefradil 100 mg/day on the frequency of total angina, prolonged angina (i.e., persisting >20 min) episodes, and sublingual nitrate consumption, during consecutive one-month treatment periods in 20 patients (age 51 ± 12 years) with the CSFP. Results: Without changing epicardial vessel diameter or rate-pressure product, mibefradil reduced the number of vessels exhibiting TIMI-2 flow from 18 to 5; furthermore, mibefradil significantly improved the TIMI frame count only in those vessels exhibiting TIMI-2 flow (28 ± 18%, p < 0.005). Compared with placebo, mibefradil significantly reduced total angina frequency by 56% (p < 0.001), prolonged episodes of angina by 74% (p < 0.001), and sublingual nitrate consumption by 59% (p < 0.01); furthermore, mibefradil improved physical quality of life as assessed by the Health Outcome Study Short Form-36. Conclusions: These angiographic and clinical improvements produced by mibefradil support a microspastic pathogenesis of the CSFP. |
Keywords: | Coronary Vessels Heart Conduction System Humans Coronary Disease Mibefradil C-Reactive Protein Troponin I Calcium Channel Blockers Coronary Angiography Echocardiography Blood Flow Velocity Electrocardiography, Ambulatory Treatment Outcome Cross-Over Studies Double-Blind Method Patient Compliance Blood Pressure Heart Rate Diastole Systole Dose-Response Relationship, Drug Adult Middle Aged Female Male Statistics as Topic Biomarkers |
Rights: | Copyright © 2004 American College of Cardiology Foundation. Published by Elsevier Inc. |
DOI: | 10.1016/j.jacc.2004.03.055 |
Published version: | http://dx.doi.org/10.1016/j.jacc.2004.03.055 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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